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Where did our family doctor go?

By Jay MacDonald ·
Friday, November 16, 2012
Posted: 10 am ET

While we were all watching the fireworks surrounding last summer's Supreme Court battle over President Barack Obama's historic health care reform, more than a few of our family doctors were quietly boxing up their belongings and heading to greener pastures, if not out to pasture.

One of the unfortunate side effects of the Affordable Care Act is that the investment it requires in health care communications, quality documentation and patient management may prove beyond the means of the kindly family doctor you've known for years.

"Probably the most dramatic effect on primary care physicians as fallout from the Affordable Care Act is that they no longer want to continue in small private practices and instead are joining larger physician groups or becoming attached to hospitals," says Dr. Ron Greeno, who chairs the public policy committee of the Society of Hospital Medicine, a trade group for hospital-based health care providers.

According to Greeno, about 50 percent of physicians in this country now work for hospitals, while only 12 percent consider themselves sole practitioners. "Independents have trouble making the economy of scale work to stay in business," he says.

No, family doctors are not disappearing, exactly. In fact, they're in demand like never before. The Association of American Medical Colleges says we could be short 21,000 primary care doctors by 2015.

But the growing demand today is coming from large physician groups that are staffing up to form health care networks called "accountable care organizations," or ACOs. With a little patient management and coordination with other providers, ACOs are poised to share in the money they save Medicare, the 800-pound gorilla and No. 1 payer in America's waiting room.

"One of the reasons for the exodus is, if you look at the ACO regulations under Medicare, one of the requirements is that they have to have a primary care component," says Dr. Greeno. "They don't have to have a hospital or specialists, but they do have to have primary care physicians."

All this sudden consolidation will eventually be good news for your family, your health insurance and taxpayers in general if health care reform achieves its goal of containing medical costs while rewarding quality, not quantity, of care.

In the meantime, be sure to ask your family doctor to notify you in case of any change of address.

Follow me on Twitter: @omnisaurus

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lobo joe
November 21, 2012 at 11:34 am

This is just symptomatic of what's going on in the country. When labor is being replaced by executives ( on overhead)who know little or nothing about what they manage, how can costs be reduced?

How can the healthcare industry improve when " not for profit" healthcare operations sock away obscene sums of money to use as a cushion?

In all probability, many of the lowlifes should probably be pounding big rocks into small rocks in a high security jail. Doctors and subscribers are bearing the brunt of the burden these white collar criminals are placing on the public.

November 21, 2012 at 10:07 am

The author is right about one thing, we are losing our GP's, my PCP just closed his practice and moved to Canada. Does that tell you anything about doing business in the USA? Our healthcare costs are astronomical and insurance companies don't want to pay, that combination that's not a formula for a quality health care system. Despite the propaganda our politicians spew, we no longer lead the world in healthcare, and we're fading fast.

healthcare professional
November 21, 2012 at 9:17 am

This article is remarkably flawed. I would love to see a few statistics here. It seems to me that primary care doctors have been fleeing to larger organizations for the past 12-15 years, mostly because of poor reimbursement from insurance companies and the inability to negotiate like larger organizations. What company does this author work for? If anything, The health care act will actually help primary care doctors.

November 21, 2012 at 8:40 am

Why is there no mention of the role Nurse Practitioners and Physicians Assistants play to meet the growing demand of primary care in America? Further, the trend out of primary care and into more lucrative speciality areas has been a long time trend - not born out of the Affordable Care Act.

November 21, 2012 at 2:58 am

the insurance industry has had control of the medical profession for decades. i have had very good docs and have helped older folks get good care. it would be nice to hear about the effort of getting through med school financially, the incredible hours of internship and the passion to give the best medical care possible. in our litigious society their first challenge in private practice is to get malpractice insurance. the cost of personal health care is not an issue for top insurance execs. understandably they answer to stockholders for their income. if anyone has a doc that they appreciate let the doc know!i am thankful for healthcare professionals.M

Not Me
November 21, 2012 at 1:52 am

Yep R.Brown,
Somebody have to take the blame for the miserable condition that America is in.

November 21, 2012 at 1:11 am

So all is well? It's only going to hurt a little at first?
That is very reassuring. Just for the record... did anyone delete any info from your talking points?

November 21, 2012 at 1:11 am

2004 - Executive Order 13335 call for the complete computerization of healthcare

2007 - President Bush calls for all US citizens to have Electronic Medical Records by 2014

I don't understand why President Obama keeps taking the hit for things that were put into law prior to his initial election. He does indeed support it but, he didn't dream it up as part of the AHCA (Affordable Health Care Act).

I thought part of reporting news and information was to get all the facts sorted out so that the reporting and the news would be accurate/factual.

Andrew G
November 21, 2012 at 12:05 am

Dr. Greeno of the Society of Hospital Medicine is incorrect about why small physicians join larger groups. It is for one reason and one reason only: Insurance contracts. The hospital based physicians and larger medical groups all have higher overheads (amount of health care dollars they spend everything other than the physician salaries) than small groups, so for each dollar paid by the insurer and patient for healthcare less goes to the physician. But indepedent physicians get much poorer rates of pay from larger insurance companies than large hospitals for the same service, so they join the hospital for the better paying insurance contracts so that although the employed physician gets less of the dollars paid by the insurer for each piece of care rendered, a lower percentage of a bigger amount is more than a larger percentage of a smaller amount.

So the act of driving physicians into large groups has resulted in higher overall cost of care.

November 21, 2012 at 12:02 am

I used to be a Democrat my whole life....... blah, blah, blah. XXXXX-Republican, you are not fooling anyone. You are a dyed in the wool Democrat. You are using an old and tired technique. Claiming to be a 'Reformed Republican' to bolster your argument, while cranking out leftist talking points doesn't work anymore. It is just another lie. Please stop. You have a brain. Try using it.